Infants in the newborn intensive care unit (NICU) are vulnerable due in part to the critical stage of their neurodevelopment and also because of the noxious nature of many procedures that they experience as part of the standard and common life-saving interventions that they bear. Such procedures can range from something as innocuous as a diaper change to invasive “skin breaking” procedures, such as catheter placements and circumcision.
Each of these procedures can be cause for pain and distress in infants and possibly associated with both immediate and longer-term poor health outcomes. Simply put, procedures undertaken by these infants can carry a neurological burden or load that may be harmful to infant development. Currently, there is controversy in the literature as to when and how procedures should be performed in the NICU; with some advocating for the grouping or “clustering” of procedures, and others pointing to the detrimental synergistic effects of such a strategy. Because an average of 14 distress-causing procedures are performed on these infants in the NICU per day, it can be advantageous for clinicians to better understand the effects of these procedures.
The measurement, monitoring, and/or indication of distress and pain may assist clinicians in determining, in a clinically meaningful manner, the timing, number, and nature of procedures to be performed. Distress and pain, however, are a challenge to measure, and particularly so with non-communicative or non-verbal patients, such as newborn infants. Some methodologies for measuring pain in newborns includes the use of “pen and paper” scales that are filled out by clinicians to arrive at what is commonly referred to as a “pain score.”